HomeMy WebLinkAbout1999-011450 - tearoff/reroof PERMIT
�CIT'� OF ORONO PERMIT TYPE: — -.
2750 Kelley Parkway- P.O. Box 66 �:��"��`-:-'�t'v�=
Crystal Bay, Minnesota 55323 Permit Number: �;� ��,,�-;�.;
(612) 473-7357 Date Issued: _ _ _ _
' SITE ADDRESS:
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I REMARKS:
FEE SUMMARY:
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APPLICANT PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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1'otal Fee: $ /�'7_ �� `=-� Date Received: -� - �S-
Entered By: ��-� Perm.it#: � D � �
CITY OF ORONO - BUILDING PERMIT APPLICATION �
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A.11 information must be submitted in full before plan review �vill be started. .
(please print all information) '
THE APPLICAh'T IS: (circle one) O�VNER OR CONTRACTOR ^
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JOB SIT'E ADDRESS: � ��� � ' � i., �lJ�, ZIP: �� �J� �
NA1�IE OF Oti�'ER: C iQ.V luU C�Q !I��QC�`�-�� PFiONE: (home) �I � I ^('���7`] �I
(work)
MATI�I�i TG ADDF.ESS: �.���Q � �.,��✓s� CI'TY: ZIP: ��
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CON'I'RACTOR C�i�t�l�l1���{,y�} ���';' t��'� PHONE �� ( Z �j'� /'�Z 3 Z I'
C01�1'TACT PERSON: ��.vlvt��.�-�:- MOBILE/PAGER:�� �- �CF(0��f�3(�
MAII� .Itii'Gr ADDRESS: �I -7 C� 6 bY1 rti �. �'1(,' 1 CIT�S�: 1?7��v``� _ZIP: -_��
STATE LICENSE: # �12��
ARCHITECT/ENGINEER: P�IONE:
MA.ILING ADDRESS: CITY: ZIP:
��,�; REGISTRATION#
TYPE OF tiVORK: New Addition Accessory Structure
Move Remodel/Alteration �( Land Alteration
PROPOSED tiVORK(describe in detai�: 1�(��� ��--� ���'�('� t�'j��)�C�C �����
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
EST .ni IATED CONSTRUCTION VALUATION (excludin;land): $ ��� � �(� �� �
I hereby apply for a building permit and I acknowledge that the information above is complete and
accurate; that the work will be in conformance with the ordinances and codes of the City and with
the State Build�z� Code; that I understand this is not a pernut and work is not to start without a
pernut; and th�t the work will be in accordance with the approved plan.
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APPLICAi��''S SIGNAT'URE: ;���tiv � l.U(����) DA'TE: `�/ �Ct�� (`�,
NOTE! Parade o Homes events require separate permit approval by Police Department and
City Counci160 days prior to the event. Non permitted events will not be allowed.
. ,
Sec.13.Q4 RIGFTfS OF SLJB,fECTS OF DaTa '
Sutd. 1. Type of data, The righ�s of individual on whom�he dam is sroced or to be scored shall be as set forth in this sccaon.
Subd.2. IntormaQon reqirired to be given indiYidual. ?.n individual asked W supply priva[e or confidendaI dara concerniag himself shal!
be infora:cd o,`: (a) the purpose aad incended use of the czqucssed dara within the collecang State agency,polidcal subdivision,or sacewide rysum;
(b)whe4':et he rray rsfuse or is_legalIy requir.d to supply che rqucsud data;(c)any Iaiown coasequence arisiag from his suppiying or refusing to supply
privace or connder.da!data;ar.d(d)the idendry of other persoas or encides auchocizcd by state or federal law ro rcceive tfie daca. 'Ihis requiremenc shall
noc apply when an ir:dividuaI is asked to supply invesdgadve daa,pursuanc ro secdoa 13.82,subdivuion 5, �o a law enforcemenc officer.
'I;�e eer.imissioner of rcvenue mav vlac� che nodc- rauired und-r this subdivision in the individual income rax or orooem raz refund
instrucdons inscezd of on chose forms.
Subd.3. Access to data by individual. Upon requcsc to a responsible authority,an individual shall be informed whccher he is che subjecc
of stor:d da[a on individuals,aad whether ic is ctassiFi:d as public,privace or confidenaal. Upon his further r.quest,aa iadividual who is the subje:c
of stored Qrivace or public dam on individuals shall be shovm che dara wichouc any charge to him and;if he desires,shall be informed of the eoncanc
ar.d meaning of that dara. Aher an individual has been shown[he priva�e dac�and informed of ics meaning,the dara ne:d not be d'uclosed ro him for
siz mondu thereafter uniess a dispute or acaon pursuant to this secdon is pending or addidooal dan on the individual has been collecced or ereacrd.
Tne respocuibla au[horiry shall providt copies of che privacr or pubfic data upon tequest by the individual subject oF che data. Tha responsible authociry
may require �he requesring person to pay che accual coscs oi making, cerdfying,and compiling the copies.
The responsible auchoriry shall comply immediately,if possible,wi�h aay requesc made pur5uant to this subdivision,or wichin five days of
the date of the request,ezcluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the requesc
wichin that dme,he shall so inform the individual,and may have an addidooal five days wichin which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data i�not accurate or complete. An ir.dividual may contest the accuracy or completeness of public or private
dara conceming himself. To exercise this right,an individual shall noafy in wricing[he responsible auchoriry describing the nature of the disagreemenc.
The responsible au�horiry shall within 30 days ei�t;er: (a)correct[ha data found to be inaccurace or incompiete and aaempc to nadfy pasc recipien�s oF
inaccurste or incomple�e data, including recipien�s named by [he individual:or(b)nodfy the individual thac he believes che dact to 6e correct Data
in dispuce shal(be disclosed only if the individual's sta�ement of disagreem:nt is inctuded wi�h the disclosed data.
The decerminaaon of the responsibla au�horiry may be appealed pursuant to the provisions of tha adminisaarive procedure act relaang to
contesud cases. •
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd.2, "Ri;hts of subjects of data", we would like to inform you that your request
for a permit or license from the City of Orono or any of its departments may require you to furnish certain private or
confidential information.
You are notified that:
1. Zhe information you furnish will be used to decermine your qualification for[he permi[or license requested.
2. You may refuse to supply data, but refusal may require that the City deny the permit or licease.
3. The information may be shared with ocher local, stace or federal agencies to the e�tent necessary to process
the permit or license.
4. If your requested permit or license requires Council action to approve, some information may become ,
public. ;
5. You have certain ri�hts under M.S. 13.04 (available upon request) to review private data onyourself.
6. Your full name is required to process this application or permit.
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I understand my ri;hts as stated above.
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